Abstract

Background

Momelotinib (MMB, GS-0387, CYT387) is a JAK1 and JAK2 inhibitor under investigation for the treatment of myelofibrosis. Preliminary results of a phase I/II core study (n=166) were previously reported. Subjects who achieved at least stable disease in the core study could continue MMB treatment in an extension study (n=120). Final data from the phase I/II core study and updated data from the extension study are presented.

Methods

Subjects with myelofibrosis categorized as IPSS intermediate-2 or high risk, or intermediate-1 risk with symptomatic splenomegaly or hepatomegaly and/or unresponsive to available therapy, were enrolled. Following a dose escalation phase, subjects were treated on a dose expansion phase in the core study with MMB at either 150 mg or 300 mg once-daily, or 150 mg twice-daily for 9 months. In the extension study, MMB was at the same dose the subject tolerated and derived clinical benefit from in the core study. Clinical responses were adjudicated according to IWG-MRT criteria.

Spleen Response was defined as ≥ 50% reduction in palpable splenomegaly that lasted ≥ 8 weeks (wks) for baseline splenomegaly ≥ 10 cm, plus resolution of palpable splenomegaly that lasted ≥ 8 wks for baseline splenomegaly > 5 to < 10 cm. Anemia Response was defined as transfusion-free interval of ≥ 12 wks for baseline transfusion dependence, plus ≥ 2 g/dL rise in hemoglobin (Hb) for baseline transfusion independence and Hb < 10 g/dL. Baseline transfusion dependence was defined as ≥ 2U RBC transfusion in the 30 days prior to first dose of MMB or identified as transfusion dependent in medical history.

Results

As of April 2013, 58 of 120 subjects remained on treatment in the open-label extension study, with median treatment duration of 507 days (range 23-1036) for both core and extension studies. Based on interim analysis, the most common reasons for discontinuation from the extension study were disease progression (n=13), investigator's decision (n=12), and consent withdrawal (n=10), with 2 drug-related adverse events (both peripheral neuropathy) that led to study discontinuation.

Efficacy data for the core and extension studies are depicted in table below.

Table

Number of Subjects (%)
Total enrollment 166 (100) 
Spleen Response 
Baseline palpable splenomegaly > 5 cm 148 (89) 
≥ 50% reduction in palpable splenomegaly that lasted ≥ 8 weeks for baseline splenomegaly ≥ 10 cm: A (A/148) 51 (34) 
Resolution of palpable splenomegaly that lasts ≥ 8 weeks for baseline splenomegaly > 5 and < 10 cm: B (B/148) 6 (4) 
Spleen Response A + B (A + B/148) 57 (39) 
Anemia Response 
Transfusion dependent at baseline 72 (43) 
Achieved transfusion independence on study for 12 weeks among those who were transfusion dependent at baseline: C (C/72) 49 (68) 
Transfusion independent with Hb < 10 g/dL at baseline 39 (24) 
Transfusion independent with Hb < 10 g/dL at baseline and has rise in Hb ≥ 2 g/dL on study for 8 weeks: D (D/39) 10 (26) 
Anemia Response C + D (C + D/111) 59 (53) 
Number of Subjects (%)
Total enrollment 166 (100) 
Spleen Response 
Baseline palpable splenomegaly > 5 cm 148 (89) 
≥ 50% reduction in palpable splenomegaly that lasted ≥ 8 weeks for baseline splenomegaly ≥ 10 cm: A (A/148) 51 (34) 
Resolution of palpable splenomegaly that lasts ≥ 8 weeks for baseline splenomegaly > 5 and < 10 cm: B (B/148) 6 (4) 
Spleen Response A + B (A + B/148) 57 (39) 
Anemia Response 
Transfusion dependent at baseline 72 (43) 
Achieved transfusion independence on study for 12 weeks among those who were transfusion dependent at baseline: C (C/72) 49 (68) 
Transfusion independent with Hb < 10 g/dL at baseline 39 (24) 
Transfusion independent with Hb < 10 g/dL at baseline and has rise in Hb ≥ 2 g/dL on study for 8 weeks: D (D/39) 10 (26) 
Anemia Response C + D (C + D/111) 59 (53) 

Median time to onset of Spleen Response was not yet reached (range 6-693 days), median duration of Spleen Response was 324 days (range 56-936). Median duration of 12-week transfusion independence was not yet reached (91-987 days), median duration of Anemia Response was not yet reached (57-987). Constitutional symptoms assessment at 3 months for the core study showed ≥ 50% improvement in 72%, 46%, 77%, 100%, and 74% of subjects with pruritis, cough, bone pain, fever, and night sweats respectively.

Most common Grade 3 or 4 treatment-related events were thrombocytopenia (29%), neutropenia (5%), and elevated lipase (4%) without clinical pancreatitis. Peripheral neuropathy was reported by 38% of subjects, all ≤ Grade 2, with 17 subjects experiencing neuropathy at baseline. Four subjects transformed into acute leukemia (1 in core study, 3 in extension study). There was no treatment-related death.

Conclusion

Prolonged administration of MMB for treatment of myelofibrosis is well tolerated and has an acceptable safety profile. MMB is efficacious in durably reducing myelofibrosis-related splenomegaly as well as improving transfusion requirement and disease-related symptoms. These data form the basis for the phase 3 randomized study of MMB in myelofibrosis.

Disclosures:

Gupta:Novartis: Lecture fee, Lecture fee Other; Novartis: Consultancy; Incyte: Consultancy; Novartis: Research Funding; Incyte: Research Funding. Bavisotto:YM Biosciences: Consultancy. Kawashima:Gilead Sciences: Employment. Lee:Gilead Sciences: Employment. Kowalski:Gilead Sciences: Employment. Deng:Gilead Sciences: Employment. Niforos:Gilead Sciences: Employment.

Author notes

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Asterisk with author names denotes non-ASH members.